Mild Traumatic Brain Injury Android Mobile App For Health Care Professionals

The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) teamed with the National Center for Telehealth and Technology (T2) to develop a mobile application called the Mild Traumatic Brain Injury (MTBI) Pocket Guide.  It is a free mobile application developed to provide health care professionals with a comprehensive, quick reference that includes clinical practice guidelines for assessing and treating service members and Veterans who have sustained a MTBI. 

App Screenshot

The mobile application is free and available for download on Android smartphones.  It is not yet available for iPhone users.  Since the mobile application was specifically intended for healthcare professionals who care for service members and veterans, it is not currently appropriate for use for other victims of a MTBI.  To download the app, go to: https://market.android.com/details?id=org.t2health.mtbi. 

New MMR Device Approved to Diagnose Traumatic Brain Injuries

A new device was recently cleared by the FDA to help diagnose brain injuries in patients.  The Siemens Biograph mMR system is the first machine to simultaneously perform a positron emissions tomography (PET) scan and a magnetic resonance imaging (MRI) scan.

PET scans involve a radioactive injection that traces blood flow, while MRIs produce images of the brain through the use of magnetic fields.

“The Siemens PET/MRI system allows two tests to run simultaneously without having to move the patient to a different scanning system,” said FDA representative Alberto Gutierrez in a statement.  “Minimizing changes in a patient’s position between tests allows for physicians to compare images more easily and helps them get the most accurate information possible.”

The two-in-one scanner both saves time and reduces radiation levels exposed to patients.  The system has been cleared for anyone who needs diagnostic PET or MRI imaging, with an exception for people with implanted electronic devices like pacemakers or defibrillators.

TBI May Be Helped By Early Nutrition Intervention

A report by the Institute of Medicine, commissioned by the U.S. Defense Department, recommends that in the first 24 hours after a traumatic brain injury (TBI), patients need to receive a level of nutrition that represents more than 50 percent of the injured person’s total energy expenditure and that provides 1 to 1.5 grams of protein per kilogram of body weight.  This nutrition level should be continued for two weeks in order to reduce inflammation and swelling of the brain and provide enough energy to help the brain repair itself.  Early feeding was found to mitigate the effects of head injuries and reduce mortality in critically ill people by between 25% and 50%.

 "The one major [conclusion] is a focus on getting protein and calories in as quickly as possible," said John Erdman, a nutrition researcher at the University of Illinois, who headed the panel of independent experts that produced the report.

 TBI among U.S. soldiers is a growing problem.  The Defense Department says reported cases have tripled to more than 30,000 in the past decade, reflecting injuries from so-called improvised explosive devices, or IEDs, that troops frequently encounter in Afghanistan and Iraq.

 Also, because of the parallels between some types of TBI found in combat personnel and those found in civilian brain injuries, such as concussions from traffic accidents and sports-related injuries, the nutritional interventions explored in this report are relevant for nonmilitary populations.

 Outside the military, some 52,000 people in the U.S. die each year from TBI, and about 1.5 million patients report to emergency rooms annually with head injuries.  As many as 3.8 million people suffer such injuries playing sports each year, says the Brain Trauma Foundation.

 The Institute of Medicine’s committee suggests that more research be conducted on a number of other possible benefits for nutritional interventions in TBI victims, including any long-term benefits of nutrition.

Long-Term Depression Linked to TBI

About 30 percent of traumatic brain injury (TBI) patients will develop clinical depression, a level three times higher than the general population, according to a new study from Vanderbilt University.  By examining more than 100 previously published studies done over several decades on patients that had experienced TBIs resulting from motor vehicle accidents, falls, assaults, and sports injuries, the Vanderbilt researchers were surprised to discover that the incidence of depression seems to hold steady for people with TBIs even years later.

 “Any patient who has a traumatic brain injury is at a real risk for developing depression, short and long term,” said Dr. Oscar Guillamondegui, study co-author and professor in Vanderbilt’s Division of Trauma and Surgical Critical Care. “It doesn’t matter where on the timeline that you check the patient population – six months, 12 months, two years, five years – the prevalence is always around 30 percent across the board.  In the general population about 9 percent to 10 percent of people have depression.”

 The study didn’t show a distinction between mild and severe brain injuries, meaning a patient who sustains a concussion might be just as likely to develop depression as one with a fractured skull and severe bleeding on the brain.

 “Nine months out, they may have developed depression as a result of the injury, but because the injury seemed mild they may not have had a visit with a physician who could pick up on the problem,” said study co-author, Melissa McPheeters, a health-care epidemiologist and co-director of Vanderbilt’s Evidence-based Practice Center.

 “Patients and their families need to know about this,” McPheeters said. “They need to know what to look for because they are the ones who will see the changes first.”

 The researchers also suggested that practitioners should ask about whether a patient has a history of TBI, when they are initially seen for symptoms such as irritability, restlessness, anxiety, and sleeplessness, so that both conditions can be treated together.

Research Underway to Develop Drug to Help TBI Victims

A chemistry professor at the University of Notre Dame is working on research intended to create a drug that could be given to a patient immediately after a traumatic brain injury to slow or reduce injury to the brain.  In December, Professor Mayland Chang received a $100,000 grant from NFL Charities (a charitable foundation of National Football League owners) to design and develop a drug for the treatment of TBIs.  When a brain suffers an injury, it causes biochemical changes that lead to tissue damage and the death of some brain cells.  Professor Chang and a colleague at the University of Missouri have been working on developing and defining inhibitors to block those chemical changes, potentially saving brain cells that otherwise would die.  They have found that some compounds will rescue as much as 60% of the brain that was destined to die.  Chang is currently testing a compound she developed on mice.  But human testing is still several years away. 

Opening Day for Colorado Rockies Brings New TBI Protocols

Major League Baseball and the Major League Baseball Players Association have adopted a new series of protocols under the new joint policy regarding concussions.

The biggest change is the creation of a seven-day disabled list (DL) which can be used instead of rushing a player back too soon after a possible concussion or placing him on the 15-day disabled list.  The seven-day disabled list will aim to allow time for the concussion to clear, prevent players from returning prematurely, and help clubs keep a full complement of players during the player’s absence.  If a player on the seven-day DL is out for more than 14 days, he will automatically and retroactively be transferred to the 15-day DL, effective with the first day of the initial placement, and with the prior 14 days applying to the initial 15-day maximum term.  This is implemented on a trial basis for the 2011 season.

Some of the other new key protocols include:

•Mandatory baseline neuropsychological testing requirements for players and umpires during Spring Training, or when a player joins a club during the season, formalizing a process that most individual Clubs follow;

•Protocols for evaluating players and umpires for a possible concussion, including during incidents typically associated with a high risk, such as being hit in the head a by a pitched, batted or thrown ball or by a bat; being in a collision with a player, umpire or fixed object; or any time when the head or neck of a player or an umpire is forcibly rotated; and

•Protocols for clearing a concussed player or umpire to return to activity; prior to the time that a concussed player is permitted to play in any game (including Major League, Minor League or extended Spring Training games), the Club must submit a “Return to Play” form to MLB’s Medical Director; submission of the form is required irrespective of whether the player was placed on the Disabled List.

A committee of experts created the policy, which will oversee the manner in which concussions are diagnosed initially and will be used to determine when players and umpires can return to the field following a concussion.  The Commissioner's Office will conduct an orientation for club medical staffs regarding the new protocols, and each club will be required to have a mild traumatic brain injury specialist in its home city.

Jake Snakenberg Youth Concussion Act signed by Governor

Just yesterday Gov. John Hickenlooper signed into law a bill that requires coaches of youth sports to be educated about concussions.  It requires that coaches receive education on how to recognize a concussion, that a player is removed from play if a concussion is suspected, and that the student athlete must be signed off by a medical professional before returning to play.

The law applies to coaches of all public and private middle schools, junior high schools, high schools, club, and recreation youth athletic sports.

"Most likely, kids this age do not have the knowledge to recognize themselves the symptoms of a brain injury," State Senator Nancy Spence (R-Centennial), a sponsor of the bill said.  "This bill is one that will keep athletes active and safe."

The proposed bill is named in memory of Jake Snakenberg, who was a 14-year old freshman football player at Grandview High School when he passed away after suffering from what doctors diagnosed as Second Impact Syndrome.  Doctors believe that in the previous week’s game, Snakenberg suffered an undiagnosed concussion and had not recovered before returning to the field and subjecting the brain to further injury.   Snakenberg died of a closed head injury in September 2004 at the age of 14, a day after collapsing during a Grandview freshman football game.  My son Drew was also 14 in 2004 when he suffered several successive concussions during sports activities, ultimately sustaining a large left-sided epidural hematoma.  This bill, which becomes effective January 1, 2012, will hopefully prevent any further young Colorado athletes from permanent injury or death as a result of participation in youth sports activities.